Provider Demographics
NPI:1417077892
Name:PATRICK J. LENAHEN, M.D., PC
Entity Type:Organization
Organization Name:PATRICK J. LENAHEN, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LENAHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-482-1141
Mailing Address - Street 1:5735 RIDGE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1745
Mailing Address - Country:US
Mailing Address - Phone:215-482-1141
Mailing Address - Fax:215-482-9758
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1745
Practice Address - Country:US
Practice Address - Phone:215-482-1141
Practice Address - Fax:215-482-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033940E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD033940EOtherMEDICAL LICENSE
PA00012475210001Medicaid
PAE52784Medicare UPIN
PAMD033940EOtherMEDICAL LICENSE